Mental Wellness from a Christian Perspective

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Most of us know that exercise is good for our physical health. It helps maintain strength and flexibility as we age, improves weight control, lowers blood pressure, reduces the risk of diabetes and heart disease, and improves immunity.

Few of us realize, though, that exercise is just as important for preserving mental health. For those of us who currently struggle or have struggled in the past with depression, exercise can take on a whole new role as part of our mental health treatment plan.

Exercise – as a treatment? Absolutely!

The first large scale research study on the antidepressant effects of exercise was done in the US in the 1990’s, by Dr. Jim Blumenthal. The study took 156 patients with a diagnosis of clinical depression, and assigned them randomly to treatment with either Zoloft (a common prescription antidepressant) or exercise. You might think that for an exercise regimen to be effective against depression, it would need to be very intense. Strenuous, bathed-in-sweat, “feel the pain” sessions of vigorous activity for an hour or two at a time, likely every day.

Ready for some great news?

All Dr. Blumenthal had his patients do was take a brisk half-hour walk three times a week. That’s it. No marathon running sessions, no grueling make-your-neck-veins-bulge weight lifting. Just walking. (Most of the patients involved in the study were middle-aged and quite out of shape – so they likely couldn’t have completed an intense regimen anyway!)

In the study, this relatively low ”dose” of exercise was shown to be more effective than Zoloft in the longer term! The two treatments actually had about equal in effectiveness for the first several months, but by ten months into the study, the exercisers were much more likely that the medicine-takers to be depression-free. And since this first landmark study, many other clinical trials have shown exercise to be an effective treatment for depression.

If the research isn’t enough to convince you, how about the opinion of an associate professor of psychiatry at Harvard Medical School? This is what Dr. John Ratey, author of SPARK: The Revolutionary New Science of Exercise and the Brain, says about exercise:

“It is simply one of the best treatments we have for most psychiatric problems.”

Exercise is not just a helpful little adjunct, something to possibly add on to a “real” treatment program. It is a powerful treatment in and of itself. Wow!

What does exercise do in the brain that makes it so powerful?

Exercise changes the levels and activity of key brain chemicals and hormones. By doing that, it changes brain function. Think of it this way: it has the same effects as psychopharmacological medication. Really, exercise IS medicine. Except that this medicine has side effects that anyone would be happy to accept: weight loss, prevention and better management of diabetes and heart disease, and greater strength and endurance.

Let’s just look at one amazing effect of exercise in detail.

Exercise prompts the production of a compound called BDNF (brain derived neurotrophic factor). This powerful protein is a growth hormone produced by nerve cells. Dr. Ratey calls it “Miracle-Gro for the brain”, because it literally acts like fertilizer. BDNF stimulates the growth of brain cells, and increases the number of connections between them (scientists call these processes neurogenesis and neuroplasticity). These functions allow our brains to grow and change throughout our whole lives.

Depression causes levels of BDNF to plummet. With longer lasting depression some parts of the brain – for example the hippocampus, which is involved with memory – will actually start to shrink. Learning and memory will be impaired. Exercise combats this effect, by reversing the trend and actually increasing BDNF production. This revitalizes the brain in a way nothing else can.

So, would you like to use exercise to get more refreshing sleep, improve your concentration and memory, and boost your mood?

Here’s the exercise prescription:

Choose an aerobic activity (the aim is to do repetitive movements with large muscle groups, which increases your heart rate)

Do this activity for at least 30 minutes, three times a week

Hopefully this is already a lot more understandable than the hieroglyphics your doctor may scribble on a prescription pad, but let’s clarify a few points for good measure.

Common choices of aerobic activities would be walking (the absolute winner, as it is doable just about anywhere, by anyone), jogging, biking or swimming. The key thing is it has to be continuous activity – not stop and go. For exercise to be effective, your heart rate has to get up and stay up steadily for at least 30 minutes. So unfortunately, taking a leisurely walk your dog and pausing repeatedly for the “sniff and sprinkle” doesn’t count.

You may be wondering how high your heart rate really needs to be. First, I’ll address those who like numbers and technical definitions. Aerobic means that your pulse is 60 to 90% of your maximum heart rate. (Your maximum heart rate is the number 220 minus your age). Obviously, if you’re just starting out with an exercise routine, aim for the low end of the spectrum. Then as your body gets used to the activity, you can nudge the intensity higher.

For those who aren’t into numbers, graphs of target heart rates, and digital gizmos, here’s a simple way to assess your workout: With aerobic exercise, you want to be able to speak, but feel it’s a little “choppy”. If you can speak in long sentences – or sing! – push yourself a little harder. On the other hand, if you can’t speak at all because you’re gasping for breath, tone it down.

Remember to start small, and work up gradually – especially if you haven’t done any regular exercise for a while. But hang in there, and you’ll see the benefits! At the 30 minutes, three times a week level, most people with depression start feeling better within a few weeks.

Trust me, I was a long-standing couch potato, a confirmed nerdy bookworm who was never involved with sports even as a teenager. The most physical activity I ever did regularly as a young adult was Hungarian folk dancing (and that was greatly influenced by the fact that a certain good-looking, single young man was in the dance group. He now happens to be my husband.)

Now, having found a combination of activities that I feel comfortable doing, and recognizing the powerful effects on my well-being, I make it part of my routine to have 4-5 hours of physical activity a week. It is crucial in controlling my diabetes, helping me lose weight (over 60 pounds to date), and preventing a relapse of depression.

Doesn’t getting to the root of a problem just make sense? Here’s a story to illustrate.

One day, in a small community that was built up around a river, a young man heard wailing. He noticed a baby floating downstream in the river. He quickly jumped in, swam out in the strong current, and grabbed the infant. Luckily it was still alive and saved by his heroic effort.

The next day as the man was working in his yard, he again heard a pitiful cry. Shockingly, there was another baby floating down towards him! Again, he braved the dangerous waters and saved the infant from sure death.

In the following days and weeks, more and more infants came bobbing down the river. The young man, worried that he wouldn’t always be able to hear the cries, set up a monitor at the water’s edge, with an amplifier that would sound in his barn and house. He organized watches, recruiting others in the community to take turns being available to make the bold rescues. Families were found to take in the babies and nurture them.

Finally one day, an amazing story appeared in the paper. An evil worker in the orphanage just a mile upstream from them had been arrested by police. He had been trying to solve their over-crowding challenges by getting rid of some of the newest arrivals.

Now, I sincerely hope that nothing like this has ever happened or will happen in real life. But it brings about the obvious point: Why didn’t anyone in the heroic community that was trying to save all the babies ask, “Where are those babies coming from? How are they getting in the river in the first place?”

As my son would say, “Well, duh!”

We can see some of this misguided emphasis in the approach to depression treatment. Even though science has shown that clinical depression is not caused by low levels of serotonin and other neurotransmitters, what is actually known to contribute is not being publicized. Approaches that have been proven to work, are extremely safe and are relatively inexpensive are not – by and large – being actively supported by conventional medicine.

So, here comes “Depression Causes 101”.

What all medical organizations will admit and actually do have in their texts, literature, and websites – although it may take some searching to find it – is that depression causes can be grouped into three broad classes: biological, psychological and social. This is called the bio-psycho-social model of depression. (I know, I know, the medical community just loves its fancy jargon).

Some more holistically-minded professionals might even include a fourth area: the spiritual. I believe, though, that a more Biblical way of looking at life is to consider one’s faith as foundational. An easy way to picture it is to think of the spiritual life as the ground, and the basic areas needed for mental wellness (the biological, psychological and social) as the three legs of a stool. Sure, each leg has to be strong, and they all have to be equal in length or balanced for our mental functioning to be stable. However, if the stool isn’t on a firm, level foundation the seat isn’t going to be steady no matter how you perch on it!

Let’s look at these three categories in greater depth.

When considering biological causes, I know I used to automatically think of genetics. Perhaps it was an implication that came with the chemical imbalance theory: certain people just have an inherited tendency for depression. The DNA coding for the manufacture of brain hormones was just faulty.

Yet in the great deal of research that has been done, no specific genes have been isolated that are linked to depression. I’ve heard opinions that only about 20 per cent of depression is truly genetic. For the rest, while there may be a genetic susceptibility, outside factors determine whether the illness actually comes about.

But what about the many instances we see where multiple generations in a family are all suffering from depression? Isn’t that proof that genetics are heavily involved?

What investigators say is that there is a much greater influence from learned behaviour – the old nurture versus nature issue. Many of the skills learned from our family are greatly involved with our vulnerability to depression. Things like communication and relationship skills, problem solving, even a basic attitude of optimism versus pessimism.

The other aspect to consider is the epidemic rise in depression in the last two generations. This is an illness that has gone from relatively uncommon in our grandparents’ era (with a prevalence of about 1 in 100 people) to now extremely common (a prevalence of about 1 in 10 in the general population). A tenfold increase in such a short span of time strongly implies outside influences – our genes just don’t change that fast!

There are many other factors, though, in the biological category besides genetics. If we think of our body as being a chemical environment – consider the exact pH and oxygen levels, precise glucose quantities, and all the hormones and needed to keep our body and brain functioning – it becomes easier to see how many things in our physical world can affect our mental state.

The four major factors that physically influence our brain, are nutrition, exercise, sleep, and sunlight exposure. All of these factors have direct effects on the supply of vital building blocks needed for our tissues, our energy, and levels of hormones that regulate essential functions.

Who doesn’t remember his or her mom’s simple advice to “eat right, get enough rest, and go outside and play”? I could say moms are always right, but being one myslef I might be biased! It’s just good, sound, basic healthy living.

In later posts, I’ll look at more specifics of how each of the other factors in the biological category affect depression, and how we can influence them.

The second category, psychological, may seem a little intimidating. How many of us have any idea of how our thought processes operate? Yet there are some basic concepts that can help a great deal. The average person is estimated to have sixty thousand thoughts a day. I have no idea how psychologists came up with that number – the main point is that we have have A LOT of thoughts.

Psychological research reveals that our thoughts directly affect our emotions, and in turn our emotions affect how we behave.

Because of the effects of thoughts on our emotions and behaviour, certain types of psychotherapy can be very effective in helping deal with depression. Please note, however, that I said certain types of psychotherapy. Some models of psychotherapy (for example, the humanistic model) are founded on unbiblical principles. The distinctions between the various common types and the ways one can use basic concepts to help in day to day life will be the topic of one of my next posts.

The third major category of depression causes is social. God designed man for relationship – with Him, and with each other. In relationships, we need to consider both the quantity and quality of our interactions. Spending both quality and quantity time with the Lord is vital, and I’d encourage everyone to seek out a church with good Biblical teaching that emphasizes a relationship with Jesus.

The same principles apply to our human relationships. Obviously, if we allow ourselves to become so rushed and overscheduled that we rarely have time to spend others, that’s not good. And making sure we have good fellowship with brothers and sisters in Christ is crucial. It’s no surprise that there are many exhortations in the scriptures about fellowship. In Hebrews 10: 24-25 we are commanded to “consider one another in order to stir up love and good works, not forsaking the assembling of ourselves together…”

However, consider also the quality of your interactions. This is determined to a great extent by your social skills. The term social skills implies that human relationship is an area that can be developed. That one realization can cause a profound shift in perspective. For my whole life up to my late thirties, I considered myself shy and awkward around people. I literally told myself, “That’s just the way I am.” Telling myself that, as well as adding to it the natural conclusion, “So that’s the way I’ll always be,” made me completely closed to any possibilities for improving my skills.

The foundational keys for healthy relationships are all in the Bible. In the future I will share here how I was able to become more comfortable in my interactions. If this is an area of concern for you, allow yourself to meditate on the idea that change can happen (are we not told that with God all things are possible? Matt 19:26). Be open to guidance from the Word and the Holy Spirit.

While the key concepts as presented here are basically simple, I also realize that making changes and incorporating them into everyday life is far from easy. It is why I am involved with peer support groups, including a program called Mood Mastery, which is a ten week workshop hosted periodically by at a few Christian churches in Calgary. If a group seems too overwhelming, consider ‘buddying up’ with someone, and doing a study of the book The Depression Cure, by Dr. Stephen Ilardi.

Praying that you will become open to new possibilities for managing your mental health,

Welcome to Renewing Your Mind, a blog dedicated to the mental wellness of Christians.

I am a believer who trained as a medical doctor, someone who has experienced severe depression – to the point of being hospitalized seven times and receiving 99 shock treatments. Thankfully, I’ve also experienced recovery. Recovery that came about from the use of basic lifestyle strategies and the strengthening of my faith. I currently do not practice medicine, but specialize in mental wellness education and peer support.

This blog will be more than dry info on mental disorders and checklists of symptoms and suggested therapies. I want to dispel misinformation and myths about mental illness. I feel called to share powerful principles that can help people on a recovery journey.

To give examples of facts that are not widely known:

The chemical imbalance theory has had mounting evidence against it for decades. It is officially considered “dead”

People with mild to moderate depression (the majority of sufferers) respond better and have more favorable long term results with lifestyle therapy

Long term use of psychotropic medication (antidepressants and antipsychotics) can lead to a huge reduction in life expectancy

The majority of depression is not caused purely by genetics

Please note, I am not “anti- medication”. I am “pro” effective treatment. I am also “pro” a thoughtful use of pharmaceuticals, always weighing the benefits versus the potential risks.

Evidence shows that lifestyle approaches are more effective as the first approach for mild to moderate depression. So much so that in other parts of the world (such as the UK) guidelines were changed many years ago to make lifestyle change the first proposed “treatment”. In more severe cases of depression, or if lifestyle approaches are not possible or are not enough, certainly there times where medication is appropriate and necessary.

Warning: If you are on medication, DO NOT change your dose or stop it without consulting your prescribing physician. It can be dangerous to suddenly change or stop these types of medications.

I encourage people to take control and use holistic methods (those which are aligned with Biblical truths) to help them live their lives full of passion and energy. It is about a spirit-filled, intentional life founded on a healthy lifestyle. The way, I believe, God designed us to live. The way that if applied faithfully will help prevent, manage and – at times – even resolve illnesses.

I’ve always had an interest in health and helping people – definitely a good thing for someone who worked as a family doctor for eight years! But for the purpose of my current work, my own personal experience is even more important that my medical training. For years I was completely disabled; a hopeless shell of a person wearing the official label of severe, chronic, treatment-resistant depression. Even with trying every drug available and numerous drug “cocktails”, as well as seven courses of shock treatments, I remained severely depressed. I had to give up my medical practice, and at times couldn’t even take care of my own pre-school age son.

The fact is, I didn’t recover because of medications and treatments. (I did have some psychotherapy that was helpful. I’ll write at a later date on which forms of psychotherapy are proven effective and are consistent with a Christian perspective). I got better mainly because I got engaged, took responsibility, and started asking myself, “What can I do personally to get myself better?” I then was blessed to be guided and supported in my journey.

Mental wellness depends on a healthy lifestyle and the intentional application of basic principles.

You may be thinking, “That’s it? A healthy lifestyle resolved a chronic, severe depression? One that wasn’t helped by the most intense medical treatments?”

That’s exactly what I’m saying.

Currently I’ve been relapse-free for over a decade, and off antidepressants for nine years. I’m passionate, productive and most importantly have a personal relationship with Christ. I work part time facilitating peer support groups and giving presentations on depression education. Not bad for someone for whom returning to work was not even discussed any more. Who was given grave counselling that her risk of suicide was ten to fifteen per cent. Who was told that she’d need to be on medications the rest of her life, and that even if she had stable periods the likelihood of relapse was practically 100%.

What if my experience was just a fluke? Or a miracle from God in my own personal situation?

There are those who know me personally now, who’ve witnessed all or part of my journey to recovery, who say my healing was a miracle. However, not an instantaneous miracle: one day I was suicidal and the next I was cheerful and completely functional. It was a gradual progression that resulted from a steady provision of key relationships and knowledge. I was provided the right tools and supports by the right people at the right times. Then, when I applied the principles consistently, I slowly came out of my severe depression.

Please note that as I got better, I started doing research into the strategies I was using. I wanted to be certain I was doing everything possible to maintain my mental health and prevent the dreaded relapse (I call it “the big R”). I was also curious as to how common it was for a depression sufferer to be so unresponsive to the widely promoted conventional treatments.

The very first book I read – The Emperor’s New Drugs by Irving Kirsch – was suggested to me by a neuropsychologist. My new family doctor had referred me to this specialist after I requested some memory testing. I had discovered years earlier that I suffered from amnesia due to the shock treatments, however none of my previous doctors had done any testing. ***

It was that book that first suggested to me the possibility that I wasn’t an exceptional case in my failure to respond to antidepressants. The author showed, after reviewing the study data submitted to the FDA (the Food and Drug Administration in the U.S., responsible for the approval and regulation of pharmaceuticals) on four major antidepressants, that the effectiveness of antidepressants in mild to moderate depression was not really much better than a sugar pill or placebo. Even in severe depression the difference between the medications and the placebo was not huge (although it was significant).

Thus began my quest for more information.

I had many questions. What has been show to work better than medications? Why isn’t that information being made more widely known? Why are the side effects of drugs not being discussed in greater detail? Is it possible to come off of medications, even if one has been on them a long time? And so on.

A key point I’d like to make is that I couldn’t have made this journey without Jesus. At my deepest point, I was desperate. After I realized my memory was getting progressively worse with the shock treatments, I knew I had to stop them. I also knew the medical options had been exhausted.

It was then that I turned to Jesus. I’m certainly not proud of how it came about; it was more of a “What have I got to lose” philosophy than anything else.

Although I had grown up in a Christian home, the experience was one of saying rote prayers and attending church services. In later years, even attending services became secondary to working on call or other “more important” activities. I hadn’t really known my saviour or been familiar with the Word. My many years of scientific training influenced me, raising doubts about God as creator and sustainer of the universe. As I became more and more ill, I withdrew and stopped even attending worship services.

Then at the time of my crisis God, in His grace, provided. Even though my attitude was not right, God honored His promise – as I drew nearer to Him, He drew nearer to me. Over time, as I started reading the Word, attending Bible studies and learning about Him, I was greatly strengthened and discovered that He is my rock. I have realized the glorious meaning of Jesus’ finished work on the cross.

I’ve learned that there are times He provides solutions and the strength to apply them, there are times I’ve had to wait for solutions, and there are times when it seems there is no solution when I can still lean on Him, feel His presence, and know that He does have a plan.

Faith has been proven in research studies to positively affect physical and mental health.

I’m excited to support believers in their journey to mental wellness. Although I do work in secular circles as well, with you I can fully share about how fundamental faith is to a balanced, purposeful life. Note that although I may talk in principal about spiritual disciplines and faith, that will not be my focus. I would encourage everyone to spend time in the Word and find a Bible-believing church for fellowship and spiritual support.

Will the lifestyle principles I advocate about bring about cures for everyone?

No. People benefit to varying degrees by applying these concepts – although most can expect to feel much better. And the benefits will be physical as well mental. That’s because we’re talking about basic health principles that will have “side effects” such as weight loss and improved blood sugar control. It’s a common sense approach to depression. God’s design is awesome – given the basics the body (including the brain) will maintain itself.

Please realize, though, that even with following the best lifestyle, bad things can happen. God is sovereign, and we do not understand His ways. What we are told is to take responsibility for what we can change.

To be absolutely transparent, even though I’ve been encouraged for years to start a blog, I never had the nerve to do it. I still am somewhat (OK, make that moderately or significantly) anxious! I’m not a techie, I’m not blog-savvy, I’m not even on Facebook regularly. Change scares me, as my husband who sees me get nervous about trying out a new app on my phone will tell you. It took me months before I stopped carrying printed-out directions and trusted Google Maps.

But it’s time. Time for word to get out that there is an alternative to a medication-only approach. Time for people to know that organized psychiatry has – for decades – been presenting a less-than-complete view of depression and mental illness. Time for believers to know that the principles of healthy living are presented in the Bible and it’s crucial to follow them. Time for an integration of spiritual life and sound physical health practices.

In future posts, look for information on the causes of depression, the myth of chemical imbalance, specifics about how the pharmaceutical industry influenced psychiatry guidelines and treatments, details on which lifestyle strategies work and tips on how to implement them, which supplements may be helpful, the influence of social media, and more.

To God be the glory throughout this process, as He made it all possible!

**The lack of monitoring for severe side effects from treatments is also a concerning issue, but I won’t get into that here. I have what is called retrograde amnesia, which is a memory loss for events that occurred before my treatments. Mine is quite severe, so that I have no recollection of the majority of my life before the shock treatments.

Resources

Our Peer Support service provides the opportunity for anyone – individual, family member or professional – looking for a connection with others, who is new to the mental health and/or addiction community, looking for information about a mental health diagnosis, or the chance to speak with someone with lived experience. Email at peer@cmha.calgary.ab.ca.

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